HomeMy WebLinkAbout24-409 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-4os 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 01 — 11 — 2024 1916 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
SUNSET BLVD NE ST e✓
MILEPOST 300 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e I405 ON RAMP
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ,/NO D:6232808727 0 11
30
6❑ LAST NAME BOZHKO FIRSTNAME JESSICA MIDDLE I 1 1 2 31
INITIAL
STREET ❑✓ 11351 SE 299 CT CITY AUBURN ST WA ZIP 98092 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 05 1— 30 — 2000 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATFBit BKS2512 sTArI WA VIN#' WBA3R1C52FK194623
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE IVEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 1 2015 BMW 435 CP DAMAGE YES NO YES❑ No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO THE GENERAL WA6501827 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEcnLLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064549617
16 a
LAST NAME ARNDT FIRST NAME MAGEN MIDDLE D
INITIAL
17 STREET NEW ADDREs7 300 VUEMONT PL NE APT K104 CITY RENTON ST WA ZIP 980564588 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK Y�EsI I I NOF YEs t l NO�
19 LICENSE STATE WA SEX F MMDDW 03 _ 09 _ 2001 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑LICENSE I 21❑ PLA E# CKG7086 TArE 41
WA VIN# 1N46L4EW3PN417328 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2023 MAKE /1J/$$ MODEL SQL)'/M�Q STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 4918047E3147AIN 1 5VE."Le ❑ ,J� CITATION# CHARGE
25 UQ,
LEGALLY YES N J
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE44450
COLLISION REPORT III III III III III 111
1591972 CASE# 24-409
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BRYAN GROZAV 01-11-24 08:35 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1/25/2024 9:55:46 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 7:29 Pry TIME POLICE ARRIVED',7:24 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE44450 CASE# 24-409 OF COLLISION01/11/24 19:16
NARRATIVE
CASE 24-409
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Thursday January 11th, 2024, at approximately 19:21, 1 responded to a 911 call regarding a two-
vehicle collision at Sunset Blvd NE and the 1405 north on ramp within the City of Renton, King
County, Washington.
'CALL REMARKS: 2 MVA.. NON INJURIES.. BLOCKING.. WB LANES OF SUNSET..
UNIT ONE: WHITE 2015 BMW 4351 WASHINGTON LICENSE: BKS2512
UNIT ONE DRIVER: JESSICA I BOZHKO (DOB: 5.30.2000)
UNIT TWO: BLACK 2023 NISSAN ALTIMA: CKG7086
UNIT TWO DRIVER: MEGAN D. ARNDT (DOB: 3.09.2001)
1 arrived on scene and contacted the involved parties. I confirmed there no injuries. No one requested
aid and said they were fine. Megan reported the following; she was traveling west on Sunset Blvd NE
when unit one turned in front of her to merge onto the 1405 on ramp.
After talking to Megan, I contacted Jessica who reported the following; she was merging onto the 1405
on ramp when she was hit by unit two. Jessica indicated she had never driven on the road before or
merged onto 1405 at that location.
It was determined Jessica failed to yield the right of way to unit two who had the right of way.
I provided Megan and Jessica a copy of the SECTOR exchange of information form. Both vehicles
had minor damages and able to drive.
This concludes my involvement in this case.
I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.
Electronically signed by B. Grozav #12489 on 1.11.2023 at 20:34 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE44450 CASE# ' 24-409 DATE AND TIME 01/11/24 19:16
OF COLLISION
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